Already this year, nine hospitals across the country have filed for bankruptcy protection, posting record profit losses as a result of several factors contributing to revenue cycle mismanagement. As a result, more hospital systems are considering bankruptcy as their only option for financial relief. Fi-Med, an industry leader in compliance and predictive analytical tools for hospitals and healthcare systems nationwide, offers risk-based auditing software as the solution, allowing users to diagnose and address common coding issues that cost healthcare facilities millions of dollars.

Declining patient payments, increased debt levels, and penalties incurred as a result of overbilling all account for such losses and the decreased rates of reimbursement.(1) As the insurance landscape continues to evolve, patients are increasingly on the hook for larger portions of their medical bills. Traditionally, hospitals and healthcare providers have received up to 90% of reimbursement from private insurers and governmental agencies.(2) However, due to high-deductible insurance plans, patients are now forced to pay as much as 30% of their healthcare bills out-of-pocket; as a result, hospitals lose out on revenue collection, as many medical bills go unpaid.(2) As much as 65 cents out of every dollar billed to patients goes uncollected.(2)

Furthermore, fraudulent billing practices have already led to an increase in healthcare facility audits and court actions against hospitals and providers who are found to be overbilling. One report from the Centers for Medicare and Medicaid Services found that hospitals account for 88% of Medicare program losses, in large part due to physician “up-coding”—charging for more expensive services that were not performed—as well as other documentation errors.(3) Since 2010, governmental recovery audit contractors have worked to audit hospitals and healthcare systems for billing and payment errors, which has substantially increased the administrative burden on healthcare facilities and resulted in costly denials of payments.(4)

A large part of the problem for healthcare facilities is the time and attention to detail it takes to ensure full compliance with regulations and implementation of proper coding for accurate reimbursement. Adrian Velasquez, CEO and Founder of Fi-Med, creator of REVEAL/md, says, “It takes tremendous effort for hospitals to get to the root of coding issues that cost them millions of dollars, and many healthcare facilities simply don’t have the manpower to perform such a task. In holding to the status quo, hospitals risk a visit from governmental auditors who could determine that the hospitals have been overpaid—and the money then has to be repaid. It’s a position no hospital administrator wants to be in, especially if the facility is already experiencing financial distress.”

A possible solution to the problem is the incorporation of analytical software, such as REVEAL/md, into existing hospital billing programs. This secure, subscription-based service evaluates a facility’s existing billing data for any compliance risks by tracking provider coding behavior. As a result, hospitals can identify and take steps to improve compliance risks before any audits take place.

“Hospitals can help to avoid audits that lead to bankruptcy by using analytical tools that flag major risk factors before it’s too late,” says Velasquez. “In identifying coding errors early, it’s certainly possible to remain in compliance with the rules and dodge the bankruptcy bullet.”

About Fi-Med

Since 1993, Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk—from catching billing errors to providing high-level safeguards against compliance risk. Fi-Med is a healthcare-technology leader helping to disrupt the status quo of the increasing burden of government compliance for hospitals and hospital systems nationwide, by providing financial management and reporting services. Their strong reputation for maximizing revenue and reducing risk for hundreds of hospitals, labs, private physicians, and healthcare networks is the result of the technology tools that they have created. REVEAL/md is the keystone product for the compliance departments of healthcare providers, empowering proactive management of physician part B audits of documentation and coding. For more information, visit http://www.fimed.com.

About Adrian Velasquez

Armed with a record of extraordinary success in the business of healthcare, Adrian E. Velasquez partnered with Christine Krause to form Fi-Med Management, Inc., in 1993. Their mission: to bring business acumen and compliance expertise to healthcare providers throughout the United States. They’ve become trusted experts in the fields of financial healthcare management, compliance and risk assessment, and chronic care management. Adrian’s extensive experience as a systems administrator and national healthcare consultant formed the foundation that he harnesses today for Fi-Med clients.Sources:

Check back often for the latest Fi-Med news, or subscribe to updates below.

Enter your email address to stay on top of changing compliance requirements, get tips from our experts, and gain access to other information designed to help compliance professionals sail through RAC audits. Rest assured, we'll never sell, trade, or share your email address, and you can unsubscribe anytime.

Fi-Med is a 26-year leader in the healthcare support and management industry. Our strong reputation for protecting and recovering revenue for hundreds of hospitals, labs, private physicians, and healthcare networks means we have a 360-degree understanding of healthcare compliance, chronic care management, and revenue cycle management. Learn more about us.